老年人身体体型及其变化与新发痴呆症的关联。
Associations of body habitus and its changes with incident dementia in older adults.
作者信息
Wu Zimu, Owen Alice, Woods Robyn L, Cribb Lachlan, Alharbi Tagrid, Zhou Zhen, Chong Trevor T-J, Orchard Suzanne G, Shah Raj C, Wolfe Rory, Torres Daniel, McNeil John J, Sheets Kerry M, Murray Anne M, Ryan Joanne
机构信息
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.
出版信息
J Am Geriatr Soc. 2024 Apr;72(4):1023-1034. doi: 10.1111/jgs.18757. Epub 2024 Jan 19.
BACKGROUND
This study examined the associations of body mass index (BMI) and waist circumference (WC), as well as their short- and long-term changes over time, with incident dementia in older individuals.
METHODS
Data came from 18,837 community-dwelling individuals aged 65+ years from Australia and the United States, who were relatively healthy without major cognitive impairment at enrolment. Anthropometric measures were prospectively assessed at baseline, as well as change and variability from baseline to year two (three time-points). In a subgroup (n = 11,176), self-reported weight at age 18 and 70+ years was investigated. Dementia cases satisfied DSM-IV criteria. Cox regression was used to examine the associations between anthropometric measures and incident risk of dementia.
RESULTS
Compared to normal weight, an overweight (HR: 0.67, 95%CI: 0.57-0.79, p < 0.001) or obese BMI (HR: 0.73, 95%CI: 0.60-0.89, p = 0.002), or a larger WC (elevated, HR: 0.71, 95%CI: 0.58-0.86, p < 0.001; highly elevated, HR: 0.65, 95%CI: 0.55-0.78, p < 0.001; relative to low) at baseline was associated with lower dementia risk. In contrast, substantial increases in BMI (>5%) over 2 years after baseline were associated with higher dementia risk (HR: 1.49, 95% CI: 1.17-1.91, p = 0.001). Increased dementia risk was also seen with an underweight BMI at baseline and a 2-year BMI decrease (>5%), but these associations appeared only in the first 4 years of follow-up. Compared to normal weight at both age 18 and 70+ years, being obese at both times was associated with increased dementia risk (HR: 2.27, 95%CI: 1.22-4.24, p = 0.01), while obesity only at age 70+ years was associated with decreased risk (HR: 0.70, 95%CI: 0.51-0.95, p = 0.02).
CONCLUSIONS
Our findings suggest that long-term obesity and weight gain in later life may be risk factors for dementia. Being underweight or having substantial weight loss in old age may be early markers of pre-clinical dementia.
背景
本研究调查了体重指数（BMI）和腰围（WC）及其随时间的短期和长期变化与老年人痴呆症发病之间的关联。
方法
数据来自澳大利亚和美国18837名65岁及以上的社区居民，他们在入组时相对健康，无重大认知障碍。在基线时前瞻性评估人体测量指标，以及从基线到第二年的变化和变异性（三个时间点）。在一个亚组（n = 11176）中，调查了18岁和70岁及以上时的自我报告体重。痴呆症病例符合DSM-IV标准。使用Cox回归来检验人体测量指标与痴呆症发病风险之间的关联。
结果
与正常体重相比，超重（风险比：0.67，95%置信区间：0.57 - 0.79，p < 0.001）或肥胖BMI（风险比：0.73，95%置信区间：0.60 - 0.89，p = 0.002），或基线时腰围较大（升高，风险比：0.71，95%置信区间：0.58 - 0.86，p < 0.001；高度升高，风险比：0.65，95%置信区间：0.55 - 0.78，p < 0.001；相对于低水平）与较低的痴呆症风险相关。相比之下，基线后2年内BMI大幅增加（>5%）与较高的痴呆症风险相关（风险比：1.49，95%置信区间：1.17 - 1.91，p = 0.001）。基线时体重过轻且2年BMI下降（>5%）也会增加痴呆症风险，但这些关联仅在随访的前4年出现。与18岁和70岁及以上时均为正常体重相比，两个时期均肥胖与痴呆症风险增加相关（风险比：2.27，95%置信区间：1.22 - 4.24，p = 0.01），而仅70岁及以上时肥胖与风险降低相关（风险比：0.70，95%置信区间：0.51 - 0.95，p = 0.02）。
结论
我们的研究结果表明，长期肥胖和晚年体重增加可能是痴呆症的风险因素。老年时体重过轻或体重大幅下降可能是临床前期痴呆症的早期标志。
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